Assistive mobility devices focusing on smart walkers : classification and review

In an aging society it is extremely important to develop devices, which can support and aid the elderly in their daily life. This demands means and tools that extend independent living and promote improved health. Thus, the goal of this article is to review the state of the art in the robotic technology for mobility assistive devices for people with mobility disabilities. The important role that robotics can play in mobility assistive devices is presented, as well as the identification and survey of mobility assistive devices subsystems with a particular focus on the walkers technology. The advances in the walkers’ field have been enormous and have shown a great potential on helping people with mobility disabilities. Thus it is presented a review of the available literature of walkers and are discussed major advances that have been made and limitations to be overcome

Review and classification of human gait training and rehabilitation devices

The number of people with reduced mobility capabilities increases every year. This reduction arises mainly due to spinal cord injuries; strokes which caused hemiparesis; or due to an advanced age. This decrease in mobility is a factor that influences both their quality of life and their dependence of others in daily life. Thus, it becomes necessary to find means and tools to prevent, compensate, improve or help to restore and increase the mobility of the affected people. The main expectation is that such means help to recover or ameliorate their independence in their daily life. Traditional training employs a treadmill with a support-weight system. This training is based on the principle of repetition of all the physical movements of a gait and has shown to produce good results in terms of rehabilitation of patients. However, this therapy requires two or more therapists in assisting patients during walking, to hold and adjust the patient’s lower limbs to correctly produce the desired gait. Thus, it requires a substantial commitment and effort of the therapists [1], and it is very expensive in terms of human resources. This leads to a boost on the population healthcare and assistive services demand and, thus an increase in the need for care givers. Assistive mobility robotic devices for gait training of disabled patients in treadmills and in the ground are one successful alternative. Other alternatives include devices that allow a broader training of patients, in different ground types, and the repetition of gait movements in uphill, downhill and trip. This paper reviews state of the art training gait devices focusing on passive and active devices. Passive devices rely on the principle of Gravity-Balancing in that they try to reduce or eliminate the effects of gravity during walking. Active devices are usually classified according to three different approaches: (i) treadmillexoskeleton based devices, (ii) robotic manipulators generating different types of gait patterns, and (iii) mobilite devices. In this review, several examples of current devices are presented

Innovative gait robot for the repetitive practice of floor walking and stair climbing up and down in stroke patients

<p>Abstract</p> <p>Background</p> <p>Stair climbing up and down is an essential part of everyday's mobility. To enable wheelchair-dependent patients the repetitive practice of this task, a novel gait robot, G-EO-Systems (EO, Lat: I walk), based on the end-effector principle, has been designed. The trajectories of the foot plates are freely programmable enabling not only the practice of simulated floor walking but also stair climbing up and down. The article intended to compare lower limb muscle activation patterns of hemiparetic subjects during real floor walking and stairs climbing up, and during the corresponding simulated conditions on the machine, and secondly to demonstrate gait improvement on single case after training on the machine.</p> <p>Methods</p> <p>The muscle activation pattern of seven lower limb muscles of six hemiparetic patients during free and simulated walking on the floor and stair climbing was measured via dynamic electromyography. A non-ambulatory, sub-acute stroke patient additionally trained on the G-EO-Systems every workday for five weeks.</p> <p>Results</p> <p>The muscle activation patterns were comparable during the real and simulated conditions, both on the floor and during stair climbing up. Minor differences, concerning the real and simulated floor walking conditions, were a delayed (prolonged) onset (duration) of the thigh muscle activation on the machine across all subjects. Concerning stair climbing conditions, the shank muscle activation was more phasic and timely correct in selected patients on the device. The severely affected subject regained walking and stair climbing ability.</p> <p>Conclusions</p> <p>The G-EO-Systems is an interesting new option in gait rehabilitation after stroke. The lower limb muscle activation patterns were comparable, a training thus feasible, and the positive case report warrants further clinical studies.</p

An Optimized Design of a Parallel Robot for Gait Training

The guidelines for enhancing robot-assisted training for post-stroke survivors head towards increasing exercise realism and variability; in particular lower limb rehabilitation needs the patient to feel challenged to adapt his locomotion and dynamic balance capabilities to different virtual ground scenarios. This paper proposes a design for a robot whose end-effector acts as a footplate to be in permanent contact with the user's foot during practice: the structure is such that it enables the user's foot to rotate around three axis, differently from what is currently available in the research for gait training; the parallel kinematic structure and the dimensional synthesis allow a suitable range of motion and aim at limiting device mass, footprint and reaction forces on the actuators when rendering virtual ground. The employed methodology has been validated using ground reaction forces data relative to stroke survivors

Hybrid Neuroprosthesis for Lower Limbs

Assistive technologies have been proposed for the locomotion of people with spinal cord injury (SCI). One of them is the neuroprosthesis that arouses the interest of developers and health professionals bearing in mind the beneficial effects promoted in people with SCI. Thus, the first session of this chapter presents the principles of human motility and the impact that spinal cord injury causes on a person’s mobility. The second session presents functional electrical stimulation as a solution for the immobility of paralyzed muscles. It explains the working principles of constituent modules and main stimulatory parameters. The third session introduces the concepts and characteristics of neural prosthesis hybridization. The last two sessions present and discuss examples of hybrid neuroprostheses. Such systems employ hybrid assistive lower limb strategies to evoke functional movements in people with SCI, associating the motor effects of active and/or passive orthoses to a functional electrical stimulation (FES) system. Examples of typical applications of FES in rehabilitation are discussed

Mechatronic Systems

Mechatronics, the synergistic blend of mechanics, electronics, and computer science, has evolved over the past twenty five years, leading to a novel stage of engineering design. By integrating the best design practices with the most advanced technologies, mechatronics aims at realizing high-quality products, guaranteeing at the same time a substantial reduction of time and costs of manufacturing. Mechatronic systems are manifold and range from machine components, motion generators, and power producing machines to more complex devices, such as robotic systems and transportation vehicles. With its twenty chapters, which collect contributions from many researchers worldwide, this book provides an excellent survey of recent work in the field of mechatronics with applications in various fields, like robotics, medical and assistive technology, human-machine interaction, unmanned vehicles, manufacturing, and education. We would like to thank all the authors who have invested a great deal of time to write such interesting chapters, which we are sure will be valuable to the readers. Chapters 1 to 6 deal with applications of mechatronics for the development of robotic systems. Medical and assistive technologies and human-machine interaction systems are the topic of chapters 7 to 13.Chapters 14 and 15 concern mechatronic systems for autonomous vehicles. Chapters 16-19 deal with mechatronics in manufacturing contexts. Chapter 20 concludes the book, describing a method for the installation of mechatronics education in schools

Otimização muscle-in-the-loop em tempo real para reabilitação física com um exosqueleto ativo: uma mudança de paradigma

Assisting human locomotion with a wearable robotic orthosis is still quite challenging, largely due to the complexity of the neuromusculoskeletal system, the time-varying dynamics that accompany motor adaptation, and the uniqueness of every individual’s response to the assistance given by the robot. To this day, these devices have not met their well-known promise yet, mostly due to the fact that they are not perfectly suitable for the rehabilitation of neuropathologic patients. One of the main challenges hampering this goal still relies on the interface and co-dependency between the human and the machine. Nowadays, most commercial exoskeletons replay pre-defined gait patterns, whereas research exoskeletons are switching to controllers based on optimized torque profiles. In most cases, the dynamics of the human musculoskeletal system are still ignored and do not take into account the optimal conditions for inducing a positive modulation of neuromuscular activity. This is because both rehabilitation strategies are still emphasized on the macro level of the whole joint instead of focusing on the muscles’ dynamics and activity, which are the actual anatomical elements that may need to be rehabilitated. Strategies to keep the human in the loop of the exoskeleton’s control laws in real-time may help to overcome these challenges. The main purpose of the present dissertation is to make a paradigm shift in the approach on how the assistance that is given to a subject by an exoskeleton is modelled and controlled during physical rehabilitation. Therefore, in the scope of the present work, it was intended to design, concede, implement, and validate a real-time muscle-in-the-loop optimization model to find the best assistive support ratio that would induce optimal rehabilitation conditions to a specific group of impaired muscles while having a minimum impact on the other healthy muscles. The developed optimization model was implemented in the form of a plugin and was integrated on a neuromechanical model-based interface for driving a bilateral ankle exoskeleton. Experimental pilot tests evaluated the feasibility and effectiveness of the model. Results of the most significant pilots achieved EMG reductions up to 61 ± 3 % in Soleus and 41 ± 10 % in Gastrocnemius Lateralis. Moreover, results also demonstrated the efficiency of the optimization’s specific reduction on rehabilitation by looking into the muscular fatigue after each experiment. Finally, two parallel preliminary studies emerged from the pilots, which looked at muscle adaptation, after a new assistive condition had been applied, over time and at the effect of the lateral positioning of the exoskeleton’s actuators on the leg muscles.Auxiliar a locomoção humana com uma ortose robótica ainda é bastante desafiante, em grande parte devido à complexidade do sistema neuromusculoesquelético, à dinâmica variável no tempo que acompanha a adaptação motora e à singularidade da resposta de cada indivíduo à assistência dada pelo robô. Até hoje, está por cumprir a promessa inicial destes dispositivos, principalmente devido ao facto de não serem perfeitamente adequados para a reabilitação de pacientes neuropatológicos. Um dos principais desafios que dificultam esse objetivo foca-se ainda na interface e na co-dependência entre o ser humano e a máquina. Hoje em dia, a maioria dos exoesqueletos comerciais reproduz padrões de marcha predefinidos, enquanto que os exoesqueletos em investigação estão só agora a mudar para controladores com base em perfis de binário otimizados. Na maioria dos casos, a dinâmica do sistema musculoesquelético humano ainda é ignorada e não tem em consideração as condições ideais para induzir uma modulação positiva da atividade neuromuscular. Isso ocorre porque ambas as estratégias de reabilitação ainda são enfatizadas no nível macro de toda a articulação, em vez de se concentrar na dinâmica e atividade dos músculos, que são os elementos anatómicos que realmente precisam de ser reabilitados. Estratégias para manter o ser humano em loop nos comandos que controlam o exoesqueleto em tempo real podem ajudar a superar estes desafios. O principal objetivo desta dissertação é fazer uma mudança de paradigma na abordagem em como a assistência que é dada a um sujeito por um exosqueleto é modelada e controlada durante a reabilitação física. Portanto, no contexto do presente trabalho, pretendeu-se projetar, conceder, implementar e validar um modelo de otimização muscle-in-the-loop em tempo real para encontrar a melhor relação de suporte capaz de induzir as condições ideais de reabilitação para um grupo específico de músculos fragilizados, tendo um impacto mínimo nos outros músculos saudáveis. O modelo de otimização desenvolvido foi implementado na forma de um plugin e foi integrado numa interface baseada num modelo neuromecânico para o controlo de um exoesqueleto bilateral de tornozelo. Testes experimentais piloto avaliaram a viabilidade e a eficácia do modelo. Os resultados dos testes mais significativos demonstraram reduções de EMG de até 61 ± 3 % no Soleus e 41 ± 10 % no Gastrocnemius Lateral. Adicionalmente, os resultados demonstraram também a eficiência em reabilitação da redução específica no EMG devido à otimização tendo em conta a fadiga muscular após cada teste. Finalmente, dois estudos preliminares paralelos emergiram dos testes piloto, que analisaram a adaptação muscular após uma nova condição assistiva ter sido definida ao longo do tempo e o efeito do posicionamento lateral dos atuadores do exoesqueleto nos músculos da perna.Mestrado em Engenharia Biomédic

Gait-Assist Wearable Robot Using Interactive Rhythmic Stimulation to the Upper Limbs

Many power-assist wearable exoskeletons have been developed to provide walking support and gait rehabilitation for elderly subjects and gait-disorder patients. Most designers have focused on a direct power-assist to the wearer's lower limbs. However, gait is a coordinated rhythmic movement of four limbs controlled intrinsically by central pattern generators, with the upper limbs playing an important role in walking. Maintaining a normal gait can become difficult as a person ages, because of decreases in limb coordination, stride length, and gait speed. It is known that coordination mechanisms can be governed by the principle of mutual entrainment, in which synchronization develops through the interaction between nonlinear phase oscillators in biological systems. This principle led us to hypothesize that interactive rhythmic stimulation to upper-limb movements might compensate for the age-related decline in coordination, thereby improving the gait in the elderly. To investigate this hypothesis, we developed a gait-assist wearable exoskeleton that employs interactive rhythmic stimulation to the upper limbs. In particular, we investigated the effects on spatial (i.e., hip-swing amplitude) and temporal (i.e., hip-swing period) gait parameters by conducting walking experiments with 12 healthy elderly subjects under one control condition and five upper-limb-assist conditions, where the output motor torque was applied at five different upper-limb swing positions. The results showed a statistically significant increase in the mean hip-swing amplitude, with a mean increment of about 7% between the control and upper-limb-assist conditions. They also showed a statistically significant decrease in the mean hip-swing period, with a mean decrement of about 2.3% between the control and one of the upper-limb-assist conditions. Although the increase in the hip-swing amplitude and the decrease in the hip-swing period were both small, the results indicate the possibility that interactive rhythmic stimulation to the upper limbs might have a positive effect on the gait of the elderly